The effect of simulation training on resident proficiency in thoracolumbar pedicle screw placement using computer-assisted navigation

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  • 1 Departments of Neurosurgery and
  • 2 Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
  • 3 Orthopedic Surgery, University of Minnesota, Minneapolis; and
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OBJECTIVE

Residency work-hour restrictions necessitate efficient, reproducible training. Simulation training for spinal instrumentation placement shows significant benefit to learners’ subjective and objective proficiency. Cadaveric laboratories are most effective but have high cost and low availability. The authors’ goal was to create a low-cost, efficient, reproducible spinal instrumentation placement simulation curriculum for neurosurgery and orthopedic surgery residents using synthetic models and 3D computer-assisted navigation, assessing subjective and objective proficiency with placement of thoracolumbar pedicle screws.

METHODS

Fifteen neurosurgery and orthopedic surgery residents participated in a standardized curriculum with lecture followed by two separate sessions of thoracolumbar pedicle screw placement in a synthetic spine model utilizing 3D computer-assisted navigation. Data were collected on premodule experience, time and accuracy of screw placement, and both subjective and objective ratings of proficiency.

RESULTS

Fifteen of 15 residents demonstrated improvement in subjective (Physician Performance Diagnostic Inventory Scale [PPDIS]) and 14 in objective (Objective Structured Assessment of Technical Skills [OSATS]) measures of proficiency in navigated screw placement with utilization of this curriculum (p < 0.001 for both), regardless of the number of cases of previous experience using thoracolumbar spinal instrumentation. Fourteen of 15 residents demonstrated decreased time per screw placement from session 1 to session 2 (p = 0.006). There was no significant difference in pedicle screw accuracy between session 1 and session 2.

CONCLUSIONS

A standardized curriculum using synthetic simulation training for navigated thoracolumbar pedicle screw placement results in significantly improved resident subjective and objective proficiency. Development of a nationwide competency curriculum using simulation training for spinal instrumentation placement should be considered for safe, efficient resident training.

ABBREVIATIONS GEE = generalized estimating equation; OSATS = Objective Structured Assessment of Technical Skills; PPDIS = Physician Performance Diagnostic Inventory Scale.

Supplementary Materials

    • Table S1 (PDF 393 KB)

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Contributor Notes

Correspondence Kristen E. Jones: University of Minnesota, Minneapolis, MN. kejones@umn.edu.

INCLUDE WHEN CITING Published online September 4, 2020; DOI: 10.3171/2020.5.SPINE2067.

Disclosures Module equipment was funded and provided by Medtronic. Dr. Polly: consultant for SI Bone; royalties from Springer; support of non–study-related clinical or research effort from Medtronic and Mizuho OSI; and royalties paid to his institution from Medtronic and Globus.

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